A 56-year-old man presented with a 3-month history of a mass in the left side of his neck that had rapidly progressed in size. There were no associated fevers, pain, dysphagia, voice changes, or facial weakness. The patient was otherwise healthy and was a 1 pack-per-day cigarette smoker. Physical examination revealed a large mass at level V in the left side of his neck (Figure 1). The mass was firm to palpation and nonmobile. There were no associated mucosal or cutaneous abnormalities. Positron emission tomography and computed tomography demonstrated a 9-cm extremely heterogeneous mass in the left side of the neck, with a maximum standardized uptake value of 22.15. The patient elected to undergo neck dissection for excision of the mass.